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Making Trade Work for Public Health

Tobacco use is the leading preventable cause of death in the world today. Developing countries are now the top tobacco-consuming nations, where men and women are addicted to tobacco at higher rates than in developed countries, and have less success stopping.

Nations have responded in domestic law by implementing warning labels and anti-teen smoking measures, and in international law through the World Health Organization’s Framework Convention on Tobacco Control.

But international law may actually be hurting as much or more than it’s helping.

Earlier this year, the World Trade Organization (WTO) ruled against US efforts to reduce teen smoking. Elsewhere, tobacco multinational Philip Morris is using international investment treaties to target so-called plain-packing laws in Australia and Uruguay. Philip Morris has also been supportive of three pending challenges of the Australian legislation at the WTO.

In this month’s Transnational Dispute Management journal, I explore the first dispute, over the 2009 Family Smoking Prevention and Tobacco Control Act. Congress saw this as a hard-won political compromise. On the one hand, it took aggressive action to reduce smoking by teens by prohibiting the sale of sweet-flavoured cigarettes. (These cigarettes are particularly appealing to people in their teenage years – the so-called window of initiation that strongly influences future tobacco addiction.) On the other hand, it took seriously the warnings made consistently by the US Supreme Court, police organisations, and economists that banning cigarettes used by adults in large numbers could have serious adverse consequences for crime. A key part of this political compromise was exempting menthol from the flavoured cigarettes ban. Health researchers have shown that menthol smokers have less elastic demand, and that many would keep smoking the products even if illegal.

The WTO ruled against the US because one of the 13 banned flavors – clove – was primarily imported from Indonesia, while menthol was regulated by other means. While equity certainly requires that developing country cigarette workers be given some consideration, the WTO appellate body (staffed by trade lawyers, not health experts) made the interests of tobacco producers the only consideration that counted. As such, they went against smart, incremental policy, and sensible cost-and-benefit weighing. Indeed, if the US wants to try to comply with the ruling without reducing the number of flavours subject to the ban, it would have to ban menthol cigarettes – something that is not feasible politically or administratively.

The implications for this ruling extend far beyond the US. The World Health Organization’s framework calls for, among other things, national prohibitions on sweet tobacco products that are appealing to teens. Over 75 countries report making progress on this front. The WTO ruling could be cited to pressure other countries’ to weaken their bans on sweet products.

The Australia and Uruguay cases are also worrying. Philip Morris is arguing that warning labels go against international law and expropriate their brand value. If successful, citizens in these countries might be faced to pay the company massive compensation – all for the privilege of regulating in ways that their own legislatures and courts have approved.

How do we get international law on the right track?

In the short run, nations will understandably focus energy on winning the cases, or limiting the extent of losses. Uruguay is mounting a vigorous defence with the assistance of the Bloomberg Foundation. We can also sidestep the international law problem by lowering demand for cigarettes, as Gates Foundation grantees are doing in China, India and Africa.

But it is untenable to have international law like the health framework conflict with international trade law. WTO and investment treaty decisions with a bearing on public health could be appealed to panels with more expertise in such matters. This would create incentives to pay closer attention the regulatory logic that every country has to sort out in addressing addiction in a way that makes sense on the ground.

Better yet, costly litigation could be avoided in the first place by having trade negotiators carve out tobacco and other health matters from trade deals. This type of firewall could go a long way towards keeping kids from lighting up.

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Treaty Shopping: How Philip-Morris Cherry-Picked Worst Case BITs

Tobacco giant, Philip-Morris, has recently bought actions under investor-State arbitration mechanisms in investment treaties to challenge laws limiting (in Uruguay) or prohibiting (in Australia) the display of its trademarks in tobacco packaging. This has caused the Australian government to take a strong stance against any investor-State arbitration provisions in free trade agreements (FTAs), including exemptions from the proposed investor-state settlement provisions of the Trans Pacific Partnership Agreement (TPP), currently being negotiated.  However, a closer look reveals a broad collection of older treaties that do not contain exceptions in modern treaties that could have avoided this situation. As a multinational-enterprise, Philip-Morris has attempted to evade these exceptions by going through subsidiaries to bring claims under more favorable treaties. This reveals that Australia’s new stance against investor-State arbitration may do nothing to prevent similar claims being brought in the future.

Investor-State Arbitration Provisions: Not All Treaties are Created Equal

In recent times, a vast proliferation of Bilateral Investment Treaties (BITs) and FTAs has created spaghetti bowls (and noodle bowls in Asia) with ridiculously complex frameworks for countries and investors to navigate. To date, Australia has already entered into a number of treaties that include mechanisms allowing investors to bring action against expropriation of assets, including intellectual property, outside Australia’s domestic courts. These include FTAs with ASEAN and New ZealandChileThailand, and Singapore; and BITs withArgentinaChina, the Czech RepublicEgyptHong KongHungaryIndonesiaLao PDRLithuaniaPakistanPhilippinesPoland,RomaniaUruguay, and Viet Nam. The Australia – US FTA also states that the US and Australia “should consider” allowing investors to bring claims against the parties, but does not mandate it. Uruguay also has entered into treaties with investor-State arbitration mechanisms, includes BITs with the U.S. and Switzerland (in French).

Among these 19 Australian treaties with investor-state arbitration procedures (and the US treaty where it is optional), language varies concerning exceptions for limitations for intellectual property rights. The broadest language of these treaties contains two circumstances where exemptions are giving to expropriation obligations: for compulsory licenses and for “the revocation, limitation, or creation of intellectual property rights.” The language most often uses the following wording:

This Article does not apply to the issuance of compulsory licences granted in relation to intellectual property rights in accordance with the TRIPS Agreement, or to the revocation, limitation, or creation of intellectual property rights, to the extent that such revocation, limitation, or creation is consistent with [Chapter on Intellectual Property].

This language is found in the Australian FTAs with Chile, Singapore, and the US. It is also found in the US-Uruguay BIT and in the current US Model BIT (however these treaties direct to TRIPS instead of the IPR Chapter of the FTA).  The ASEAN-Australia-New Zealand FTA and the Australia-Malaysia FTA (which does not have investor-State dispute resolution) include exceptions for compulsory licenses but not for “the revocation, limitation, or creation of intellectual property rights.”

Language within the Intellectual Property Chapters of many of the FTAs and in TRIPS allows for limitations for IP rights. Excerpts concerning limitations for trademarks from these treaties are often worded similar to the following language:

Each Party may provide limited exceptions to the rights conferred by a mark, such as fair use of descriptive terms, provided that such exceptions take account of the legitimate interest of the owner of the mark and of third parties. (US-Australia FTA, Article 11.7(5))

Additionally, TRIPS, expressly grants countries the right to pursue public health measures in relation to IPR obligations

Members may, in formulating or amending their laws and regulations, adopt measures necessary to protect public health . . .  provided that such measures are consistent with the provisions of this Agreement. (TRIPS, Article 8.1)

The remaining English treaties, the Thai FTA and every Australian BIT with investor-State Dispute provisions (the Uruguay-Swiss BIT is only in French), provide no exceptions for exercising any limitation on intellectual property rights.  These treaties give multinational enterprises the biggest room to challenge national laws that relate to intellectual property rights and public policy. This is seen directly in each of Philip-Morris’s actions.

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As Nations Try to Snuff Out Smoking, Cigarette Makers Use Trade Treaties to Fire Up Legal Challenges

Andriy Skipalskyi was feeling proud, even triumphant, when he arrived last March at the World Conference on Tobacco or Health in Singapore.

Ukraine’s parliament had just voted to approve a public smoking ban, and its president had just signed a bill to outlaw tobacco advertising and promotion. These were revolutionary steps in chain-smoking Eastern Europe.

But Skipalskyi, a leading Ukrainian anti-smoking activist, heard little praise for his country from other delegates. As he told FairWarning: “Everyone was talking about Ukraine as the bad actor in the international arena in tobacco control.”

The reason was a bewildering move by Ukraine’s trade ministry. Within hours of the historic steps to curb smoking at home, the ministry, prodded by the tobacco industry, contested a tough anti-smoking law half a world away in Australia.

In a complaint to the World Trade Organization, Ukraine challenged the law, due to take effect December 1, that will ban distinctive logos and colors and require cigarettes to be sold in plain packs. Despite Ukraine having no tobacco exports to Australia—and therefore no clear economic interest—the trade ministry branded the law a violation of intellectual property rights under trade agreements Australia had signed.

Following Ukraine’s lead, Honduras and the Dominican Republic soon joined the attack on Australia, filing similar complaints with the WTO.

The case, which will be decided by an arbitration panel, signals an emerging pattern in the global tobacco wars. As top cigarette makers lose clout with national governments, countries around the world are adopting increasingly stringent rules to combat the public health burdens of smoking. To strike back, tobacco companies are increasingly invoking long-standing trade agreements to try to thwart some of the toughest laws.

The WTO case is only part of a three-pronged legal assault on Australia, aimed both at reversing the plain packaging law and warning other countries of what they might face if they follow its lead.

Public health advocates fear the legal attacks will deter other countries from passing strong anti-smoking measures. The “cost of defending this case, and the risk of being held liable, would intimidate all but the most wealthy, sophisticated countries into inaction,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids in Washington D.C.

The dispute underlines broader concerns about trade provisions that enable foreign companies to challenge health, labor and environmental standards. Once a country ratifies a trade agreement, its terms supersede domestic laws. If a country’s regulations are found to impose unreasonable restrictions on trade, it must amend the rules or compensate the nation or foreign corporation that brought the complaint.

Advocates say countries should be free to decide how best to protect public health, without being second-guessed by unelected trade panels. Moreover, they argue, tobacco products, which kill when used as intended, should not be afforded the trade protections of other goods and services.

Worldwide, nearly 6 million people a year die of smoking-related causes, according to the World Health Organization, which says the toll could top 8 million by 2030. With fewer people lighting up in wealthy nations, nearly 80 percent of the world’s 1 billion smokers live in low-and middle-income countries.

Countries have been emboldened to pass more stringent measures by the Framework Convention on Tobacco Control. In effect since 2005, the treaty has committed about 175 nations to pursue such measures as higher cigarette taxes, public smoking bans, prohibitions on tobacco advertising, and graphic warning labels with grisly images such as diseased lungs and rotting teeth. (The U.S. has signed the treaty, but the Senate has not ratified it. The U.S. Food and Drug Administration has ordered graphic warnings for cigarette packs, but an  industry court challenge on 1stAmendment grounds has stalled the rule.)

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Big Tobacco’s Abuse of Trade Treaties

FairWarning uncovers more evidence on how the tobacco industry abuses trade laws to block anti-tobacco measures!

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Tobacco Lawyers Attack Expert Witness Before Testimony in Quebec

A Quebec judge has agreed to hear the testimony of a prominent witness in a massive class-action lawsuit against Big Tobacco, a man the industry has labelled as biased and ill-informed.

Robert Proctor is a historian from California’s Stanford University who has published extensively on the tobacco industry in books and academic papers.

He’s also no stranger to tobaccolitigation, having testified in some 30 trials.

He was called to testify on behalf of the plaintiffs behind a landmark $27 billion lawsuit in Quebec that pits an estimated 1.8 million Quebecers against three major tobacco manufacturers.

The defendants—Imperial Tobacco Canada Ltd.; Rothmans, Benson & Hedges; and JTI-Macdonald—have argued that the dangerous health effects of tobacco have been common knowledge for decades and there was no conspiracy to hide it.

Justice Brian Riordan decided late Monday that he wanted to hear from Proctor. He admitted as evidence part of his 100-plus page report, which critiques other reports done by three industry-paid historians on how much Quebecers knew about tobacco risks.

Lawyers for the tobacco firms spent the day attacking Proctor’s credibility. They tried to convince the judge that the professor had an agenda beyond critiquing historians’ reports.

The judge allowed about 30 pages into the record.

As for the rest of his report—which one tobacco lawyer described as 75 pages of anti-tobacco advocacy—Riordan said he would take it under advisement.

Proctor doesn’t couch his words when describing what conclusions he draws about the tobacco industry from his research. He has described tobacco companies in writings as liars, cockroaches and cancer-mongers and he says cigarettes should be abolished.

Proctor did not hide his opinions Monday.

“I believe it is wrong for an industry to kill millions of people,” said the author, researcher and self-described public health advocate, during a hearing to determine whether he should be granted expert status.

“I’m open to alternative views, but I’m not neutral about what your client has done to the lungs of the world.”

Proctor, who has more than a quarter-century of experience, has testified in dozens of trials in the United States. He admits that he has earned more than $1 million for doing so. He has never once been disqualified from testifying.

“I’m fair, but I do think bad things have been done by the tobacco industry,” Proctor said under questioning.

“I don’t think the tobacco industry wanted to kill people. I think it was more negligence,” he added. “I’m glad they are being brought to justice. That’s a good thing.”

His testimony is the latest in a case that is described as the biggest class-action lawsuit in Canadian history.

It’s not common for experts to be excluded from testifying, one of the tobacco lawyers said. But he argued that the court had an obligation to prevent Proctor’s testimony.

“The Supreme Court has said as recently as 2011 that the court has a gatekeeper function,” said Doug Mitchell, a lawyer representing JTI-Macdonald.

He and other tobacco company lawyers argued that not only is Proctor biased, he knows nothing about Canada or Quebec, and he cites documents not in the record in his report.

Another lawyer, Simon Potter, representing Rothmans, Benson & Hedges, questioned whether Proctor’s testimony was necessary.

“Is this person, this expert, going to help the court, as an expert should, with objective, helpful advice from a specialized field when the court is unable to decide without it?” Potter said.

“I think the answer is no.”

But the lawyers representing two plaintiffs dismissed the arguments from Big Tobacco and said it wasn’t Proctor’s mandate to know Canadian tobacco history.

“Based on a lifetime’s work, you have certain ideas, based on evidence,” said plaintiff lawyer Bruce Johnston. “Surely that cannot disqualify you from working on a file because that would result in the most qualified people being excluded.”

Plenty of witnesses have already appeared before the Quebec Superior Court since the trial began last March, including numerous former and current tobacco industry executives.

The case has already heard more than 80 days of testimony with thousands of pages of documents filed into evidence.

It has taken 13 years to reach the trial phase. It stems from two cases that were filed in 1998, certified and consolidated in 2005 by Quebec Superior Court, and there were motions, delays and appeals before it got underway in 2012.

Proctor’s testimony on his report begins Tuesday morning.

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Anti-Smoking Progress Stalls Among U.S. Adults: Report

Although the number of adult smokers in the United States declined slightly between 2005 and 2011, there was no significant change between 2010 and 2011, health officials said Thursday.

Smoking dipped from 20.9 percent to 19.3 percent of the U.S. population between 2005 and 2011, but in the last year the decline slowed to 19 percent. Almost 44 million adults still smoke, according to the U.S. Centers for Disease Control and Prevention.

For the first time, the report gave details on the number of Americans with disabilities who smoke. In 2011, more than 25 percent of those with disabilities smoked, compared with about 17 percent of people without disabilities.

The report was published in the Nov. 9 issue of the CDC’sMorbidity and Mortality Weekly Report, shortly ahead of the American Cancer Society’s Great Smokeout on Nov. 15. This annual event encourages smokers to plan to quit on that day or plan to quit permanently.

The largest decline in current smoking occurred among young adults aged 18 to 24, dropping from more than 24 percent to nearly 19 percent.

That was welcome news for the Campaign for Tobacco-Free Kids, which released a statement from Matthew Myers, the advocacy group’s president.

“This augurs well for future declines in adult smoking,” Myers said. “The U.S. Surgeon General has found that nearly 90 percent of smokers start by age 18 and almost no one starts smoking after age 25, so these large reductions in youth and young adult smoking offer promise of greater adult smoking declines in the future.”

But the overall smoking rate remains a problem, said Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health.

“We are making some progress, but the progress is slower than we need to see given how important the effect of smoking is on our nations’ health,” McAfee said.

Progress has slowed primarily because states aren’t funding tobacco-control programs to the levels they used to, he said.

“There has been a 35 percent decrease in funding of state programs over the last few years,” McAfee said. “These are programs that have been incredibly effective.”

These programs combine smoke-free laws, increases in tobacco sales taxes, access to smoking cessation programs and media campaigns, McAfee said.

Yet these funding decreases occurred at the same time states were taking in about 35 percent more in tobacco sales taxes, he said.

According to the report, the number of adults who smoke 30 or more cigarettes a day decreased from nearly 13 percent in 2005 to slightly more than 9 percent in 2011.

During the same period, however, the number of adults who smoke one to nine cigarettes a day increased from about 16 percent to 22 percent, the CDC reported.

McAfee said that “this is a way people have responded to higher prices and also taking to heart the message of the horrific effects of smoking on their health.”

Smoking fewer cigarettes is only a benefit if it’s a step to stopping smoking altogether, McAfee said. “Smoking fewer cigarettes is not a substitute for quitting,” he said. “If you go from smoking 20 cigarettes to 10 you aren’t cutting your risk in half.”

The percentage of Americans who continue to smoke is higher than the 12 percent goal stated in Healthy People 2020, a set of nationwide health goals established by the U.S. Department of Health and Human Services.

“If you smoke, you are losing over a decade of life on average,” McAfee said. Stopping smoking not only increases life expectancy, “it’s also increasing your quality of your life. For every smoker who dies there are 20 more smokers still alive with a serious chronic condition, like chronic obstructive pulmonary disease, heart disease or … cancer.”

Erika Sward, assistant vice president for national policy and advocacy at the American Lung Association, said that “while we have made steps forward in reducing the number of adults in the U.S. who smoke cigarettes, we are not doing what we need to do [to get] the most vulnerable populations to quit, and we are not doing what we need to do to make sure people aren’t switching to other tobacco products.”

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CDC: Airports That Allow Smoking Pose Health Risks

Ventilation at five major U.S. airports with designated smoking areas does not protect passengers from the health risks of secondhand smoke, the Centers for Disease Control and Prevention warns Tuesday.

The CDC, in its first study comparing air quality at airports with and without smoke-fee policies, finds that pollution levels adjacent (within a meter or 39 inches) to smoking areas are five times higher than levels at airports that entirely ban smoking. Levels inside smoking areas, including bars and restaurants, were 23 times higher than at smoke-free airports.

“Significant secondhand smoke exposure is going on. …These are unnecessary dangers for airport employees and passengers,” says Tim McAfee, director of CDC’s Office on Smoking and Health. He says the report shows smoking areas are not ventilated enough, adding that a ban on all indoor smoking is the “only effective protection” against secondhand smoke.

McAfee says there’s “no safe level” of secondhand smoke exposure. The CDC says it causes heart disease and lung cancer in non-smoking adults and is a known cause of sudden infant death syndrome or SIDS, respiratory problems, ear infections and asthma attacks in infants and children. It says even brief exposure can trigger acute cardiac events such as heart attack.

Although federal laws ban smoking on all U.S. domestic and international commercial airline flights, they do not require airports to be smoke-free. Most airports with designated smoking areas are located in states without smoke-free laws or are exempted from such laws.

Five of the 29 largest U.S. airports, accounting for about 15% of U.S. air travel last year, allow smoking in designated public areas: Hartsfield-Jackson Atlanta International Airport, Washington Dulles International Airport, McCarran International Airport in Las Vegas, Denver International Airport and Salt Lake City International Airport.

Many passengers surveyed say they want smoking areas, says Kimberly Gibbs, spokeswoman for Dulles International Airport. Because the airport has many international flights, she says passengers switching gates cannot simply step outside for a smoke without having to go through security again. She says police patrol the airport to ensure smoking occurs only in designated lounges, situated in three of the six concourses.

Last month, the CDC measured the levels of particulate matter — an indicator of secondhand smoke — in the smoking and non-smoking areas of the five airports and compared them to the overall levels at four smoke-free hub counterparts: Chicago O’Hare International, Fort Lauderdale-Hollywood International, Orlando International and Phoenix Sky Harbor International.

Co-author Brian King, a CDC epidemiologist, says the findings are consistent with those from other studies the agency has done on secondhand smoke exposure in indoor smoking areas. Yet with the airports, he says he was surprised by the amount of air leaking from smoking rooms into adjacent areas.

The report found that the passenger boarding areas in the five airports that allow smoking have a slightly higher, but statistically insignificant, level of pollution than that found overall at smoke-free airports.

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Global Pact Adopted to Curb Illicit Tobacco Trade

SEOUL: More than 170 countries Monday adopted what World Health Organisation (WHO) chief Margaret Chan called a “game-changing” global pact to combat the illegal tobacco trade.

The treaty envisages an international tracking system which aims to halt the smuggling and counterfeiting of tobacco products — a trade which accounts for 11 percent of the total tobacco market and costs governments an estimated $40 billion in lost tax revenue.

“This is a game-changing treaty,” Chan said in an address to a meeting in Seoul of the WHO’s Framework Convention on Tobacco Control (FCTC), which has been ratified by 176 countries since coming into force in 2005.

“This is how we hem in the enemy,” she added, calling the pact a major step towards “eliminating a very sophisticated criminal activity”.

The protocol gives signatory states five years to establish a tracking and tracing mechanism on cigarettes and every other tobacco product. The system will use non-removable markings and will be coordinated globally to detect illegal tobacco trading.

Agents, suppliers and tobacco manufacturers will all have to be licensed. Manufacturers will have to carry out checks on customers to ensure they are genuine or if they have associations with criminal organisations.

In her address Monday, Chan lambasted the tobacco industry for seeking to “maintain its profits and kill at the same time” and accused it of complicity in the illicit tobacco trade.

“It is a ruthless industry that quite literally cannot afford to lose.

“It behaves like a corrosive substance that can eat and slip through any cracks or fissures in the armour of our defences,” she said.

Monday’s pact marks a departure for the FCTC, whose main focus so far has been on curbing demand for tobacco products rather than controlling the supply chain.

The Framework Convention Alliance (FCA), which groups around 300 non-government organisations working for tobacco control, said it was “excited” by the adoption of the pact, which required four years of intense negotiations.

“The illicit trade in tobacco feeds the worldwide tobacco epidemic by flooding markets with cheap producers and keeping tobacco taxes low,” said FCA director Laurence Huber.

The six-day FCTC meeting in the South Korean capital will also review guidelines on tax measures to reduce tobacco demand, recommendations on promoting alternatives to tobacco growing, and regulation of smokeless tobacco products like e-cigarettes.

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Tobacco Control: WHO Director-General Addresses History-Making Conference

Dr Margaret Chan
Director-General of the World Health Organization

Address to the Fifth Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control
Seoul, Republic of Korea
12 November 2012

Excellencies, distinguished delegates, ladies and gentlemen,

I am delighted to address this fifth session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control. Our shared goal is to see this treaty fully implemented, to see its powers fully used to reduce tobacco consumption and exposure to tobacco smoke, everywhere in the world.

As this session opens, support for the Convention has grown to 176 Parties, representing nearly 90% of the world’s population. This shows the scale of the impact you can have.

Since the treaty came into force seven years ago, the work of this conference has given more than ten articles of the Convention teeth and traction by creating supplementary instruments.

You have done so in a spirit of solidarity, fully mindful of the transnational nature of the tobacco threat, and fully aware of the need to build implementation capacity among Parties with meager resources. Success depends on a capacity to implement, everywhere.

In crafting guidelines and recommendations, this body reaches well beyond the domains of medicine and public health. You gather evidence and support from multiple sectors, like trade, finance, agriculture, education, labour, the environment, law enforcement, and the judicial system.

The work of this conference is a model of multisectoral collaboration but also of an interagency response, as you will be discussing during this session.

The Convention is a powerful instrument for prevention, but also for international cooperation. This importance has been recognized in recent political declarations on noncommunicable diseases and on the social determinants of health.

You are inspired by the preventive power of what you are doing. I can think of no other undertaking that can make such a huge contribution to better health in every corner of the world. And that includes the health of young children and unborn babies.

This has always been one of the anti-tobacco campaign’s most compelling arguments. Tobacco use is the epidemiological equivalent of a drive-by shooting. It hurts the innocent bystanders as well as those held captive by an addiction that damages their health.

You are united by a shared spirit of determination but also out of necessity, given the nature of the opposition, of the forces that are equally determined to undermine, circumvent, and interfere.

The tobacco industry behaves like a corrosive substance that can eat through, or seep through, any crack or fissure in the armour of our defences. Our response must be to seal all these cracks and fissures, one by one, with science and evidence, supported by instruments for applying this knowledge and backed by the rule of law.

This is what you are doing. This is what makes the work of this conference so monumentally important. With the guidelines and recommendations you put forward, and now with the first protocol before you for approval, you are hemming in the enemy, cutting off its options, giving it less space to manoeuvre.

As we know from experience, the tobacco industry will challenge the best science, promote arguments that have nothing to do with the facts, and fund front groups to give these arguments a cloak of legitimacy. This industry will lobby lawmakers, woo the press and, now, fund plaintiffs to challenge legislation.

In a recent and most disturbing trend, the showdown between governments, seeking to safeguard the health of their citizens, and industry, seeking to maintain its profits, has moved to the courtroom.

I know you will want to join me in congratulating Australia and Norway for recent rulings that upheld the legality of their tough control measures. We are united in our support for other countries facing similar interference.

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Pressure to End $30m Tobacco Investment

THE NSW government is considering abandoning tobacco investments after a backlash from health experts and anti-smoking campaigners.

It has for the first time admitted to having nearly $30 million invested in tobacco companies. The figures were provided in an answer to a budget estimates question asked by the Greens NSW MP John Kaye.

The NSW Treasury Corporation, known as TCorp, has at least $28.7 million invested through two trusts, the NSW Treasurer, Mike Baird, revealed.

For months, the government has refused to answer questions about its tobacco investments, which are managed by independent fund managers.

Mr Baird, and the NSW Minister for Health, Jillian Skinner, both said on Tuesday the government would review its investment in tobacco companies, and give a decision by the end of the year.

The chief executive of Action on Smoking and Health Australia, Anne Jones, said it was hypocritical for the government to allow tobacco investments when they could be easily screened out.

The director of the Public Health Advocacy Institute, Mike Daube, said he was appalled government money was invested in tobacco companies, particularly as tobacco control programs had had their funding cut in recent years.

“It is unacceptable. Sixty years after we learnt of the dangers of smoking, one million Australians have died because they smoke, and the state government shouldn’t be profiting from that,” he said. “They should take their investment out of tobacco and put it into tobacco control.”

Dr Kaye said the government could no longer hide behind the excuse of fund managers controlling investments.

He said Mr Baird had only provided him with data for two of 12 trusts.

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Tobacco Companies Reach Supreme Court To Out Throw $50B Lawsuit

Two of the largest foreign-owned tobacco companies have asked the Ontario’s top court to discharge a $50-billion lawsuit instigated against them by the provincial government. According to the lawyers of British American Tobacco and R.J. Reynolds Tobacco Company, they are going to put up a case that their respective companies shall not be included in the legal action if the appeal court lets the case proceed.

Lawyers asserted that the suit is based on a completely bogus theory that several companies plotted in the 1950s to unanimously hold back information from Ontario smokers regarding the harmful and addictive ingredients in cigarettes. The lawyers of the two companies have alleged that there is no evidence or proof of a plot ever taken place.

A total of 14 tobacco companies were sued by Ontario in September 2009 seeking health-care costs related to smoking in past and present. The province claims that these corporations are to be held accountable for billions of dollars as they misrepresented the risks of smoking and did not take sufficient steps to reduce the effects and marketed cigarettes towards children and teens.

A lawyers of British American Tobacco has written that “If it is allowed to stand… jurisdiction can be assumed over any defendant, anywhere in the world, regardless of that defendant’s lack of connection to the facts alleged or to the jurisdiction, simply by asserting bald and vaguely articulated claims that the defendant engaged in an undefined conspiracy that ultimately resulted in harm in Ontario.” It said that “such an approach cannot be correct and is inconsistent with the principles of certainly, order, fairness, and properly restrained jurisdiction.”

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Reynolds American Subsidiary Sues E-cig Maker

A subsidiary of Reynolds American Inc. is suing an Alabama electronic-cigarette retailer, accusing the company of trademark infringement of Reynolds’ Camel and Winston brands, and unfair and deceptive trade practices.

Reynolds Innovations Inc. filed the lawsuit Friday in the U.S. District Court for the Middle District of N.C. The case has been referred to a mediator.

Named in the lawsuit are SAS Technologies Inc. of Ozark, Ala., doing business as SaveASmoker.com and Save A Smoker Inc., and co-owner Eric Slaick.

E-cigs are battery-powered devices that heat a liquid nicotine solution in a disposable cartridge and create a vapor that is inhaled. Refill cartridges can be purchased in different amounts and flavors; five-packs typically cost between $9 and $18.

By comparison, a carton of cigarettes can cost between $25 and $50 for most name brands.

Reynolds Innovations said the company marketed its products using images that are “colorable imitations and confusingly similar to” the Camel and Winston trademarks.

When Reynolds filed the lawsuit, SaveASmoker.com listed as flavors “Camell Tobacco” and “Winston” on its website, as well as USA Blend – “comparable to Marlboro” – and Newport, the top-selling menthol brand of Lorillard Inc.

Brian May, a spokesman for Altria, the parent company of Philip Morris, said the company has not filled a similar lawsuit against SAS Technologies and the other companies.

Reynolds said in the lawsuit the use of such images “will continue to result in a likelihood of consumer confusion and irreparable injury to the company.”

Reynolds spokesman Bryan Hatchell said the company declined to comment beyond the lawsuit.

Slaick said Monday that the SAS has pulled all references to Camel and Winston from its website and the shelves of its stores.

The products now on its website are for its MaxxVapor Pro brand. The company lists retail locations in the Southeast for its products, but none in North Carolina.

Slaick said the company sources its e-cigarettes from a Chinese manufacturer who used the Camel and Winston imagery as part of distinguishing the styles and flavors for its product options.

“We just went with what the manufacturer provided and had not heard a complaint from Reynolds,” Slaick said. “Once we learned of the lawsuit, we pulled them off the website within minutes.

“It was never our intention to take on R.J. Reynolds or to trick consumers into thinking there was a connection.”

Reynolds has moved into the e-cigarette category with Vuse, which is being test-marketed in the Triad at select Tarheel Tobacco outlets.

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Most Women Exposed to Second-Hand Tobacco Smoke in China

Nearly two-thirds of women of reproductive age in China are exposed to second-hand tobacco smoke at home and over half are exposed in the workplace, which raises the risk of complications in pregnancy, including stillbirths and infant death.

The findings, released by the World Health Organisation on Tuesday, are from a tobacco survey conducted in China in 2010 by the centers for disease control and prevention in China, the United States and the WHO.

Around 100,000 people die from exposure to second-hand smoke in China each year, in addition to an estimated 1 million people who die from direct tobacco consumption.

Women in rural areas of China were more affected, with almost 3 in every 4 exposed to second-hand smoke at home, compared to just over half in urban areas.

“There is no safe level of exposure to tobacco smoke. Creating 100 percent smoke-free environments is the only way to protect people from the harmful effects of second-hand tobacco smoke,” said Michael O’Leary, WHO representative in China.

“Tobacco use and second-hand smoke exposure in reproductive-aged women can cause adverse reproductive health outcomes, such as pregnancy complications, fetal growth restriction, preterm delivery, stillbirths, and infant death.”

About a quarter of China’s 1.3 billion people are smokers, or about as many people as there are in the United States. But the country is gradually becoming more aware of this public health problem.

The Ministry of Health warned in May that more than 3 million Chinese would die of smoking-related illnesses annually by 2050 if nothing is done to curb this habit.

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What is the FCTC?

The Framework Convention on Tobacco Control (FCTC) is the world’s first global public health treaty. It is also the first treaty negotiated under the auspices of the World Health Organization (WHO) and is one of the most widely adopted treaties in the United Nations system.

The treaty entered into force in February 2005. It was signed by 168 of the 192 WHO member states and today there are  more than 170 WHO member states have become Parties to the convention. The United States has not yet become a Party to the treaty.

The FCTC is a legally binding treaty that requires countries bound by the treaty or Parties  to implement evidence-based measures to reduce tobacco use and exposure to tobacco smoke. When effectively implemented, the FCTC is a powerful tool to reduce the devastating global consequences of tobacco products on health, lives and economies.

The FCTC sets out specific steps for governments addressing tobacco use, including to:

  • Enact and undertake comprehensive bans on tobacco advertising, promotion and sponsorship;

 

  •  Ban misleading and deceptive terms on cigarette packaging such as “light”, “low-tar” and “mild”;

 

  • Implement rotating health warnings on tobacco packaging that covers at least 30 percent (ideally 50 percent or more) of the display areas – this may include pictures or pictograms;

 

  • Protect people from tobacco smoke exposure on public transport, and indoor work and public places;

 

  • Adopt or maintain taxation policies aimed at reducing tobacco consumption; and

 

  • Combat illicit trade in tobacco products. This requires monitoring, documenting and controlling product movement as well as including origin and destination information on packaging plus enacting legislation with appropriate penalties and remedies.

More about ASHs role with the treaty>

See WHO’s FAQ on the Treaty >

Coming soon…What is COP?

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Smoking Bans Really do Slash Heart Attacks and Strokes, Largest Ever Study Finds

  • The more stringent the laws, the better the health benefits, American researchers found
  • Hospital admissions for heart attacks fell by 15%, strokes by 16% and those for respiratory diseases such as asthma by 24%

Smoking bans dramatically reduce the number of people hospitalised for heart attacks, stroke and respiratory diseases such as asthma and emphysema, new research has shown.

In the largest analysis of smoke-free legislation to date, American researchers found the more stringent the laws, including those for workplaces, restaurants and bars, resulted in the highest health benefits. 

The research, published in the American Heart Association journal Circulation, analysed 45 studies covering the US and other countries such as New Zealand and Germany.

It found heart attack hospitalisations declined by an average of 15 per cent after communities passed laws banning smoking in areas such as restaurants, bars and workplaces.

Admissions for strokes declined by 16 per cent, while hospitalisations for respiratory diseases such as asthma and chronic obstructive pulmonary disease, were rapidly followed by a 24 per cent decrease in hospitalisation.

Exposure to cigarette smoke induces rapid changes in blood chemistry, making it much more prone to clotting. 

In someone who has narrowed or damaged coronary arteries, smoke exposure can tip the balance and cause a heart attack.

The findings are consistent with other studies that have found smoking bans are linked with a decline in cardiac problems.

Department of Health figures found the number of heart attacks in England plummeted by 10 per cent in the year after the ban was imposed in July 2007.

A similar drop was also recorded in Scotland where another study discovered a 14 per cent decrease in the year after the ban was introduced there.

Around 114,000 people die every year from smoking-related diseases.

But while many link smoking to lung cancer, the connection between it and heart attacks is less well known. About 275,000 people suffer heart attacks in Britain each year, with 146,000 of those dying.

Commenting on the research, Maureen Talbot, senior cardiac nurse at the British Heart Foundation (BHF), said: ‘The risks of passive smoking on our health are well known and this is the reason smoking legislation was introduced throughout the UK in 2007. 

‘Restrictions on smoking in public can help smokers to cut down or quit as well as reducing our exposure to second hand smoke. 

This study provides encouraging data about the benefits of a smoke-free environment on our heart health and shows that the right decision was made five years ago. 

‘If we want this downward trend to continue, policy makers should introduce further measures to reduce the appeal of smoking, such as plain, standardised packaging for tobacco.’

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In Graphic Warnings Case, Tobacco Lawyers Fight Full D.C. Circuit Review

Lawyers for major tobacco companies said Monday they do not want the full U.S. Court of Appeals for the D.C. Circuit to touch a panel’s ruling that went against the government’s controversial graphic warning labels requirement.

A divided three-judge panel of the D.C. Circuit in August ruled against the U.S. Food and Drug Administration’s requirement that cigarette packs carry graphic images that depict the dangers of smoking. Judge Janice Rogers Brown called the images “inflammatory” and said they were “unabashed attempts to evoke emotion.” The court said the proposed warning images violate the First Amendment.

The U.S. Justice Department wants the full D.C. Circuit to overturn the panel decision. Yesterday, responding to DOJ, lawyers for tobacco companies that include R.J. Reynolds and Lorillard urged the D.C. Circuit not to tangle with the panel decision. Ultimately, the U.S. Supreme Court could be asked for its assessment.

“The proposed warnings will not create more informed consumers and were never intended to,” Jones Day litigation partner Noel Francisco, lead counsel for R.J. Reynolds Tobacco Co., said in a court filing Monday. Francisco also said the images “had no measurable effect on consumer knowledge of the smoking risks the warnings address.”

DOJ lawyers said in their request that the panel decision failed to recognize the government’s interest in “ensuring that consumers and potential consumers understand the health risks of smoking.”

The tobacco company lawyers, who also include a team from Covington & Burling who represent Lorillard, said in their response that the FDA’s graphic images rule was not meant to further that government interest.

“These warnings do not address any information deficit about the health risks of smoking. Rather, consumers are already aware of the health risks addressed by the warnings,” the tobacco company lawyers said in their papers.

The warning images, Francisco said in court papers, “were not selected based on their ability to increase consumer knowledge. Instead, they were intentionally crafted to attach ‘negative affect’ to cigarettes and convey a message to consumers that smoking is not a legitimate or acceptable personal choice.”

The U.S. Court of Appeals for the Sixth Circuit rejected a challenge to the requirements, DOJ lawyers said in their petition in the D.C. Circuit.

DOJ lawyers, including Mark Stern from the Civil Division’s appellate staff, said in court papers that the panel decision“boldly declared” that the First Amendment blocks the graphic image regulations because the government failed to show how the photos have directly caused a decrease in smoking rates.

“The government’s interest in effectively communicating the health risks of smoking cannot be overstated,” DOJ lawyers said in the request for a full-court review.

That a particular image evokes emotion, DOJ said, doesn’t make a health warning inaccurate. “The warning that tobacco smoke can harm a smoker’s children evokes emotion because the warning is true, and people do not want to harm their children,” DOJ said.

The full D.C. Circuit hasn’t decided whether it will hear the case. If the government loses, DOJ could decide to ask the Supreme Court to review the dispute.

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Women Who Quit Smoking Live Decade More

Women who stop smoking before middle-age live about 10 years longer than women who continue to smoke throughout life, a new study from the United Kingdom finds.

Smoking until middle age does reduce lifespan somewhat — women in the study who smoked until age 40 were about 1.2 times more likely to die over a 12-year period, compared with those who never smoked.

However, those who smoked their whole lives were nearly three times more likely to die over that same time period, compared with those who never smoked.

In other words, women who stopped smoking by age 40 were able to avoid about 90 percent of their excess risk of dying from smoking, the researchers said. And those who stopped smoking by age 30 avoided 97 percent of this risk.

The findings of the study — which involved more than 1 million women born in the 1940s —are similar to what has already been seen in studies of men.

“Women born around 1940 were the first generation in which many smoked substantial numbers of cigarettes throughout adult life,” said study researcher Sir Richard Peto, of the University of Oxford. “Hence, only in the 21st century could we observe directly the full effects of prolonged smoking, and of prolonged cessation, on premature mortality among women,” Peto said.

Participants were enrolled in the study around age 55, and were followed from 1996 to 2011. They completed a questionnaire about their lifestyle, medical and social factors, and were resurveyed three years later. During the 12-year study, about 66,000 participants died.

At the study’s start, 20 percent of the participants were smokers, 28 percent were ex-smokers, and 52 percent had never smoked.

Those who were still smokers at three years after the study began were nearly three times more likely to die over the next nine years than those who did not smoke.

The excess mortality among smokers was mainly due to diseases that can be caused by smoking, such as lung cancer, the researchers said.

The study was published in the journal the Lancet.

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‘Smoking Will Kill Up to a Billion People’

Smoking, which is described as the biggestpublic health disaster in the history of the world with its perpetrators likened to terrorists, will kill up to a billion people worldwide this century unless governments across the world stamp down on the half-trillion-dollar tobaccoindustry, cancer experts have warned.

John Seffrin, chief executive of the American Cancer Society, issued this warning while speaking at a high-level forum of the world’s 100 leading cancer experts gathered in the Swiss resort of Lugano.

They said governments must do far more than they have done to control the global tobacco industry, either by raising cigarette prices dramatically, outlawing tobacco marketing or by taxing the multinational profits of the big cigarette firms.

According to scientists, smoking kills more than half of all smokers, mostly from cancer, and yet despite it being the single biggest avoidable risk of premature death, there are about 30 million new smokers a year.

They said that if the current trends continue – with cigarette companies targeting the non-smoking populations of the developing world – then hundreds of millions of people will be dying of cancer in the second half of this century.

Some of the experts attending the World Oncology Forum went further by calling for an outright ban on cigarettes and for the tobacco industry to be treated as a terrorist movement for the way it targets new markets with a product that it knows to be deadly when used as intended.

“We have a major global industry producing a product that is lethal to at least half the people who use it. It will kill, if current trends continue, a billion people this century,” the Independentquoted Dr Seffrin as saying.

“It killed 100 million in the last century and we thought that was outrageous, but this will be the biggest public health disaster in the history of the world, bar none. It all could be avoided if we could prevent the terroristic tactics of the tobacco industry in marketing its products to children.

“There is a purposeful intent to market a product that they know full well will harm their customers and over time will kill more than half of them. The industry needs to be reined in and regulated,” he said.

Worldwide, tobacco causes about 22 percent of cancer deaths each year, killing some 1.7 million people, with almost 1 million of them dying from lung cancer. Yet the numbers of new smokers among the young is rising faster than the numbers giving up.

The latest study into the health effects of smoking, which was published in The Lancet and involved 1.3 million women, showed that tobacco is even more dangerous than previously supposed but the benefits of giving up smoking are greater than expected.

Sir Richard Peto of Oxford University, a co-author of the Million Women study who worked closely with Sir Richard Doll, is also the scientist who first calculated how many people this century will die from tobacco-induced cancers.

“We have about 30 million new smokers a year in the world. On present patterns, most of them are not going to stop, and if they don’t stop, and if half of them die from it, then that means more than 10 million a year will die – that’s 100 million a decade in the second half of the century,” Professor Peto said.

“So this century we’re going to see something like a billion deaths from smoking if we carry on as we are. In Europe we have about 1.3 million premature deaths per year now, of which about 0.3 million are deaths by tobacco. There’s nothing else as big as that.

“If you put all causes together, you wouldn’t get a total that’s half of that caused by tobacco, and tobacco kills more people by cancer than other diseases. Smoking is still the most important cause of cancer… If you smoke a few cigarettes a day, it will be the most dangerous thing you do,” he added

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China Leader’s Job at Odds With Tobacco Ties, Brookings Says

The brother of Chinese Vice Premier Li Keqiang, who oversees public health, should be removed from his post as a top official in China’s state-owned tobacco monopoly to avoid conflicts of interest, a report published by the Washington-based Brookings Institution said.

Li, set to succeed Wen Jiabao as premier early next year, could boost his reputation as a populist leader and deflect criticism from rivals if his younger brother, Li Keming, is transferred from his position as deputy director at China’s State Tobacco Monopoly Administration, Cheng Li, a Brookings senior fellow, wrote in a report. He said Li Keming’s prominent role in the agency that runs the world’s biggest tobacco company may have set back efforts to control tobacco in the country.

Public opinion in China is becoming more important on social issues including health, environmental protection and food safety, Brookings’s Li said today. China has more than 300 million smokers, and at least 1.2 million die from smoking- related diseases each year, a figure set to rise to 2 million a year by 2020, according to the report, released two weeks before China begins a once-a-decade leadership transition.

“In all these areas, I think leaders should set examples,” Brookings’s Li said in an interview. “Particularly now that many countries, including Russia and India, are paying more attention to public health issues.”

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Smokers Left Gagging by Not-So-Plain Cigarette Packets

TOOWOOMBA’S smokers have been left gagging as new not-so-plain cigarette packets start to filter into stores.

A packet of Winfield Blues is no longer the colour its name would suggest – instead a sickly looking olive green sets the ailing backdrop for photos of health-plagued smokers in various states of decay.

The new packets, which use the same font for any brand or type of cigarette, will be the only legal packaging available from December onwards.

Free Choice Tobacconist owner Robert Anderson said his Hooper Centre store had already sold most of its old, colourful stock.

If any old packets are still in circulation when December arrives, representatives from tobacco companies will buy them back from stockists.

He believed smokers would not take the decision lightly.

“I think the new packets are obscene, but that’s what the government wants,” he said.

“If they think it’s going to stop people from smoking cigarettes, they’ve got another think coming.

“It’s the worst thing they could do if they want the votes of the smoking public . . . another nail in the government’s coffin.”

Mr Anderson said he was not worried about any negative impact on his business.

He said it would only help sales of certain smoking accessories.

“The general public feeling is that it’s a fair dinkum joke,” he said.

“I think the sale of cigarette cases (to cover the disturbing images) will really come to the fore.”

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European Commission: Will Move Ahead With Draft Revision of Tobacco Directive

BRUSSELS–The European Commission still intends to move ahead with a draft revision of the tobacco directive in the coming weeks, spokesman Olivier Bailly said Thursday, as he insisted no-one within the European Union’s executive is seeking to block new the rules on tobacco companies.

The tobacco directive is at the center of a cash-for-influence probe by the EU’s anti-fraud office which resulted in former Health Commissioner John Dalli stepping down last week. Mr. Dalli has consistently denied any wrongdoing.

“We will come with the draft revision of the directive in the coming weeks,” Mr. Bailly said. “The Commission will make this proposal. No doubt about that. So really the political commitment is there,” he added.

Any proposal would then have to go to member states and the European Parliament.

In a press conference in Brussels, in which he said he would take legal action against the Commission over what he called his ouster, Mr. Dalli repeated his concern that the directive would be blocked now that he has resigned.

He has also said that the directive was twice delayed internally by Commission officials.

Mr. Bailly declined to comment on who had delayed internal discussions, adding that the process would move ahead once a new commissioner had been appointed to replace Mr. Dalli.

Malta has put forward foreign minister Tonio Borg as a replacement. But he may not be confirmed for some weeks since there must be a hearing with the European Parliament before he is appointed.

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FCA Video Highlights Tobacco Epidemic

A billion people will be killed by tobacco this century. It has been estimated that the tobacco industry makes approximately $6,000 for every death.   This must stop! The tobacco treaty is among one of the best tools the world has today to prevent this senseless massacre that hurts the citizens of the world and our economies.   More than 150 governments will meet in a few weeks and make decisions that can help stop the tobacco related epidemic. Countries must act swiftly and wisely in order to prevent all of these unnecessary deaths.  Let us know what you think of the video and be sure to share it with friends and family.

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FCA’s Video Message to COP5 Delegates

Watch the video which highlights the devastation that the tobacco epidemic has caused.

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Secondhand Smoke Exposure For Just 20 Minutes Leads To Breathing Impairment, Study FInds

It only takes 20 minutes of secondhand smoke exposure before breathing is impaired, a new study shows.

Researchers from the University of Athens, the Hellenic Cancer Society and the Harvard School of Public Health had 15 healthy study participants go inside a chamber meant to simulate a bar or car filled with secondhand smoke particulates for 20 minutes to see how their breathing was impaired.

In just that short amount of time, air flow through the participants’ airways was impeded.

“The observed short-term effects of secondhand smoke tell us that even a short exposure is indeed harmful for normal airways,” study researcher Dr. Panagiotis Behrakis, M.D., FCCP, of the University of Athens, said in a statement.

The new findings were presented at the annual meeting of the American College of Chest Physicians; because the study has yet to be published in a peer-reviewed journal, findings should be regarded as preliminary.

Similarly, a study published in 2007 in the American Journal of Public Healthshowed that cancer-causing NNK — a compound that comes from the smoke of cigarettes — builds up by 6 percent every hour in bar- and restaurant-workers who are exposed to secondhand smoke during their night shifts, TIME reported.

“We were somewhat surprised by the immediacy of the effect and the fact that we could measure the average hourly increase,” study researcher Michael Stark, principal investigator at the Mulmomah County Health Department in Oregon, told TIME.

Earlier this year, a study in theAmerican Journal of Public Healthshowed just how many lives secondhand smoke claims in the U.S. each year: 42,000, Livescience reported.

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Smoking, Diabetes Are Risk Factors for Poor Leg Circulation: Study

New research confirms that smoking, diabetes, high blood pressure and highcholesterol levels can all raise men’s risk for poor circulation in the legs, otherwise known as peripheral artery disease (PAD).

According to the American Heart Association, PAD involves a narrowing of the peripheral (outside the heart) arteries, most commonly the vessels of the pelvis or legs. People with PAD are at increased risk for heart attack, stroke or mini-stroke. The condition is thought to affect 8 million to 10 million people in the United States.

The new study included nearly 45,000 U.S. men who were followed for more than two decades. During that time, 537 cases of PAD were diagnosed. Each of the four risk factors — smoking, diabetes, high blood pressure (hypertension) and high cholesterol levels — was significantly and independently associated with a higher risk of PAD.

Ninety-six percent of the men who developed PAD had at least one of the four risk factors when they were diagnosed with theartery disease, noted a team led by Michel Joosten of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

The investigators also found that men who did not have any of the four risk factors were 77 percent less likely to develop PAD than all other men in the study.

The risk of PAD tended to increase the longer a man had both type 2 diabetes and high cholesterol levels, the researchers added.

Two experts welcomed the results of the study.

“This important study is consistent with findings from earlier studies,” noted Dr. Kenneth Ong, acting chair of the department of medicine and cardiology at the Brooklyn Hospital Center in New York City. “It is well done due to its large population and long duration of follow-up.”

Dr. Maja Zaric, an interventional cardiologist at Lenox Hill Hospital in New York City, who treats many patients with PAD, also noted that risk factors associated with the artery disease are also typically linked to heart disease, but the relationship to PAD seems to be even stronger.

That’s especially true for smoking, Zaric said. “As a matter of fact, one of the study findings reports remote effects of smoking on PAD incidence even 20 years after smoking cessation,” she pointed out. “That should not discourage smokers from abstinence since the PAD risk amongst current smokers appears to be threefold higher than in former smokers.”

Zaric added, “now that the major risk factors for PAD in men have been identified, additional studies with specific clinical endpoints should be done to examine effects of risk factor and lifestyle modification. And not to forget, women should be studied in a similar fashion, as it is shown that presence of PAD amongst female patients had been under-recognized.”

The study was published in the Oct. 24/31 issue of the Journal of the American Medical Association.

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